Provider Demographics
NPI:1194797688
Name:SPRINGFIELD MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:SPRINGFIELD MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSCIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHOMER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-233-1500
Mailing Address - Street 1:1811 BETHLEHEM PIKE
Mailing Address - Street 2:A 108
Mailing Address - City:FLOURTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19031-1111
Mailing Address - Country:US
Mailing Address - Phone:215-233-1500
Mailing Address - Fax:215-233-1015
Practice Address - Street 1:1811 BETHLEHEM PIKE
Practice Address - Street 2:A 108
Practice Address - City:FLOURTOWN
Practice Address - State:PA
Practice Address - Zip Code:19031-1111
Practice Address - Country:US
Practice Address - Phone:215-233-1500
Practice Address - Fax:215-233-1015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003048L173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE78490Medicare UPIN
PAB37381Medicare UPIN